The Specific Aims of the Vanderbilt University Multidisciplinary Clinical Research Center (VMCRC) are: 1) To pursue a multidisciplinary clinical research scientific program that will alter the outcomes of patients with rheumatic diseases. 2) To promote and foster multidisciplinary clinical research in rheumatic diseases by leveraging institutional training and research resources and the extensive research base that supports the VMCRC and facilitate growth of new projects and the training of new investigators. The VMCRC (Director: C. Michael Stein MD; Associate Director: Wayne Ray PhD) is comprised of three clinical research projects centered around a Methodology Core that serves all projects. The three projects span a range of clinical research approaches (CRC clinical research, pharmacoepidemiology, health outcomes) and diverse rheumatic diseases (rheumatoid arthritis, lupus, osteoarthritis) central to the mission of NIAMS. Project 1 (Stein) is a clinical research/CRC proof-of-concept study using pioglitazone to define the relationships between hyperinsulinemia, disease activity and inflammation in patients with rheumatoid arthritis. Project 2 (Griffin) studies the effect of newer disease modifying anti-rheumatic drugs on the long-term outcomes of cardiovascular disease, diabetes, infection and lymphoma. Project 3 (Cooper) uses a unique local pharmaco-epidemiologic resources to address the risks of anti-rheumatic drugs administered during pregnancy. A common Methodology Core (Arbogast) provides support for the design, collection and analysis of data, and the development of new techniques for improvement of the research methodology used. An Executive Committee and an External Advisory Committee will assist in scientific direction, strategic planning and the leveraging of VMCRC and institutional resources to greatest effect. An Administrative Unit will ensure responsible, efficient conduct of research, seamless communication, fiscal efficiency and thoughtful prioritization of resources. In summary, the VMCRC brings together talented multidisciplinary clinical researchers with a track record in performing collaborative research, fostering new research and facilitating the growth of trainees. The VMCRC is situated in an environment that provides an extraordinarily rich research base as well as outstanding institutional resources and a commitment to clinical research that will facilitate success of the Center.